Efficacy of different front-of-package labeling systems in changing purchase intention and product healthfulness perception for food products in Argentina.

Objectives: To identify the front-of-package scheme-Multiple Traffic Light (MTL), Nutri-Score (NS), and black octagon Warning System (WS)-most effective in reducing purchase intention and perceived product healthfulness of drinking yogurts, cookies and cheese spreads, and to assess the joint influence of nutrient claims on the effects. Methods: Randomized-controlled experiment. A within-subjects factorial design was used to evaluate the influence of three independent factors on perceived product healthfulness and purchase intention. A total of 704 adults in Argentina were shown three mock-up products and asked to indicate which product they would buy choosing between pairs of products from different categories and to rate product healthfulness on a 7-point Likert scale. Results: The WS was the most effective in reducing purchase intention in drinking yogurts (OR:0.16, 95%CI: 0.09;0.28), cookies (OR:0.10, 95%CI: 0.05;0.18) and cheese spreads (OR:0.10, 95%CI: 0.05;0.18), and the perception of healthfulness (WS Mean score 3,63 vs No label 4,24, p<0.001), regardless of the participants' gender, age, and level of education. NS was inefficacious in reducing product healthfulness perception, while MTL had significantly increased how healthful the product was perceived (p<0.001). Nutrient claims increased purchase intention and perception of healthfulness, thus reducing the effectiveness of front-of-package labels (p<0.001). Conclusions: In line with growing evidence, our findings support that WS perform better than NS and MTL in reducing purchase intention and healthfulness perception of products with excessive amounts of critical nutrients associated with the greatest burden of diseases. Front-of-package WS are expected to facilitate the population in Argentina to make healthier decisions.

Efficacy of different front-of-package labeling systems in changing purchase intention and product healthfulness perception for food products in Argentina / Eficacia de los diferentes sistemas de etiquetado frontal en Argentina para modificar la intención de compra y la percepción saludable de productos alimentarios / Eficácia de diferentes sistemas de rotulagem nutricional frontal para mudar a intenção de compra e a percepção de saudabilidade de produtos alimentícios na Argentina

ABSTRACT Objectives. To identify the front-of-package scheme—Multiple Traffic Light (MTL), Nutri-Score (NS), and black octagon Warning System (WS)—most effective in reducing purchase intention and perceived product healthfulness of drinking yogurts, cookies and cheese spreads, and to assess the joint influence of nutrient claims on the effects. Methods. Randomized-controlled experiment. A within-subjects factorial design was used to evaluate the influence of three independent factors on perceived product healthfulness and purchase intention. A total of 704 adults in Argentina were shown three mock-up products and asked to indicate which product they would buy choosing between pairs of products from different categories and to rate product healthfulness on a 7-point Likert scale. Results. The WS was the most effective in reducing purchase intention in drinking yogurts (OR:0.16, 95%CI: 0.09;0.28), cookies (OR:0.10, 95%CI: 0.05;0.18) and cheese spreads (OR:0.10, 95%CI: 0.05;0.18), and the perception of healthfulness (WS Mean score 3,63 vs No label 4,24, p<0.001), regardless of the participants' gender, age, and level of education. NS was inefficacious in reducing product healthfulness perception, while MTL had significantly increased how healthful the product was perceived (p<0.001). Nutrient claims increased purchase intention and perception of healthfulness, thus reducing the effectiveness of front-of-package labels (p<0.001). Conclusions. In line with growing evidence, our findings support that WS perform better than NS and MTL in reducing purchase intention and healthfulness perception of products with excessive amounts of critical nutrients associated with the greatest burden of diseases. Front-of-package WS are expected to facilitate the population in Argentina to make healthier decisions.

RESUMEN Objetivos. Determinar el sistema de etiquetado frontal -semáforo múltiple, Nutri-Score (NS) y sistema de advertencia con forma de octágono negro- más efectivo para reducir la intención de compra y la percepción saludable de yogures bebibles, galletitas y quesos para untar, y evaluar la influencia conjunta de las declaraciones nutricionales sobre los efectos del etiquetado frontal. Métodos. En el estudio, un ensayo controlado aleatorizado, se empleó un diseño factorial entre los sujetos para evaluar la influencia de tres factores independientes en la percepción saludable y la intención de compra. A un total de 704 adultos en Argentina se les mostraron tres prototipos de productos; se les pidió que indicaran qué producto comprarían eligiendo entre pares de diferentes categorías y que calificaran qué tan saludable era cada producto en una escala Likert de 7 puntos. Resultados. El sistema de advertencias con octágonos negros fue el más efectivo para reducir la intención de compra en yogures bebibles (OR: 0,16, IC 95%: 0,09; 0,28), galletitas (OR: 0,10, IC 95%: 0,05; 0,18) y quesos para untar (OR: 0,10, IC 95%: 0,05; 0,18) y para reducir la percepción saludable (puntuación promedio del sistema de advertencias: 3,63; ninguna etiqueta: 4,24, p<0,001), independientemente del sexo, la edad y el nivel de educación de los participantes. El Nutri-Score fue ineficaz para reducir la percepción saludable, mientras que el sistema de semáforo múltiple aumentó significativamente cuán saludable se percibió el producto (p<0,001). Las declaraciones nutricionales aumentaron la intención de compra y la percepción saludable, lo que redujo la eficacia de las etiquetas frontales en el envase (p<0,001). Conclusiones. En consonancia con la evidencia disponible, nuestros resultados respaldan que el sistema de advertencia con forma de octágono negro funciona mejor que el Nutri-Score y el semáforo múltiple en la reducción de la intención de compra y la percepción de saludable de productos con cantidades excesivas de nutrientes críticos asociados con la mayor carga de enfermedades. Se espera que el uso de los símbolos octagonales de advertencia en la parte frontal de los envases facilite la toma de decisiones más saludables para la población en Argentina.

RESUMO Objetivos. Identificar o modelo de rotulagem nutricional frontal - tipo semáforo (Multiple Traffic Light, MTL), Nutri-Score (NS) e octógonos pretos (Warning System, WS) - mais eficaz para reduzir a intenção de compra e a percepção de saudabilidade de iogurtes líquidos, biscoitos doces e pastas de queijo, bem como avaliar a influência conjunta das alegações nutricionais sobre tais efeitos. Métodos. Estudo experimental randomizado e controlado. Foi utilizado um delineamento fatorial de sujeito único para avaliar a influência de três fatores independentes sobre a percepção de saudabilidade e a intenção de compra dos produtos. A uma amostra de 704 adultos na Argentina foram mostrados três mock-ups de produtos, e foi solicitado aos participantes que indicassem qual produto eles comprariam (escolhendo entre pares de produtos de diferentes categorias) e que classificassem a saudabilidade do produto em uma escala tipo Likert de 7 pontos. Resultados. O sistema WS foi o mais eficaz em reduzir a intenção de compra dos iogurtes líquidos (odds ratio [OR]: 0,16, intervalo de confiança [IC] 95%): 0,09; 0,28), biscoitos doces (OR: 0,10, IC95%: 0,05; 0,18) e pastas de queijo (OR: 0,10, IC95%: 0,05; 0,18), bem como a percepção de saudabilidade (pontuação média: 3,63 com rotulagem WS x 4,24 sem rotulagem, p<0,001), independentemente do sexo, idade e escolaridade dos participantes. O sistema NS foi ineficaz em reduzir a percepção de saudabilidade dos produtos, e o MTL aumentou significativamente essa percepção (p<0,001). As alegações nutricionais aumentaram a intenção de compra e a percepção de saudabilidade, reduzindo assim a eficácia da rotulagem frontal (p<0,001). Conclusões. Corroborando um corpo crescente de evidências, nossas constatações indicam que o sistema WS de rotulagem frontal tem melhor desempenho do que os modelos NS e MTL na redução da intenção de compra e da percepção de saudabilidade de produtos com teor excessivo de nutrientes críticos associados a uma maior carga de morbidade. Espera-se que a rotulagem nutricional frontal do tipo WS favoreça a tomada de decisões mais saudáveis pela população da Argentina.

Changes in the Sodium Content of Foods Sold in Four Latin American Countries: 2015 to 2018.

In 2015, the Pan American Health Organization (PAHO) published sodium targets for packaged foods, which included two distinct levels: one "regional" and one "lower" target. Changes to the sodium content of the food supply in Latin American Countries (LAC) has not been evaluated. A repeated cross-sectional study used food label data from 2015 (n = 3859) and 2018 (n = 5312) to determine changes in the proportion of packaged foods meeting the PAHO sodium targets and the distribution in the sodium content of foods in four LAC (Argentina, Costa Rica, Paraguay, Peru). Foods were classified into the 18 food categories in the PAHO targets. The proportion of foods meeting the regional targets increased from 82.9% to 89.3% between 2015 and 2018 (p < 0.001). Overall, 44.4% of categories had significant decreases in mean sodium content. Categories with a higher proportion of foods meeting the regional and lower targets in 2018 compared to 2015 (p < 0.05) were breaded meat and poultry, wet and dry soups, snacks, cakes, bread products, flavored cookies and crackers, and dry pasta and noodles. While positive progress has been made in reducing the sodium content of foods in LAC, sodium intakes in the region remain high. More stringent targets are required to support sodium reduction in LAC.

Food marketing and gender among children and adolescents: a scoping review.

BACKGROUND: Pervasive marketing of unhealthy foods is a contributing factor to the growth of the global epidemic of childhood and adolescent overweight and obesity. Sex and gender differences come into play in the design of and responses to these marketing strategies, contributing to the perpetuation of stereotyped behavior and generating disparities in food choices and health. The purpose of this paper is to review the current literature regarding gender differences in food marketing design and perception among children and adolescents to facilitate evidence-based policy dialogues to address gender-based health disparities in NCD prevention. METHODS: Scoping review of articles published in scientific journals in English and Spanish, from 2003 to 2018, that addressed the influence of food marketing among children and adolescents including a gender perspective. The methodological quality of each article was assessed following criteria specific to each study design. RESULTS: From a total of 37 articles (39 studies) included in the review, 17 were experimental and 22 had descriptive, cross-sectional designs. Twenty-one studies were found to have low methodological quality, while 10 and 8 were of medium and high quality, respectively. A total of 23 studies among children and adolescents found gender-based differences. Differences were found in the following dimensions: food marketing on intake; responses to specific marketing; perceptions and attitudes towards food marketing and marketing regulation initiatives; exposure to food advertising and gendered marketing content. The evidence was not conclusive in any of the dimensions. CONCLUSIONS: The evidence suggests that food marketing has a similar impact on the consumption of unhealthy foods on boys and girls, but boys were found to be exposed to food advertising more intensively and their preferences to be more affected by this exposure, coinciding with a male-dominant advertising content. Limitations of these studies include taking gender as an unproblematic construct equivalent to biological sex and the lack of studies focused on developing countries. As gender is a cross-sectional dimension that interacts with other factors driving health disparities, an integrated gender perspective is needed to develop effective, evidence-based policies to control food marketing and tackle the childhood overweight and obesity pandemic.

Measuring cost and affordability of current vs. healthy diets in Argentina: an application of linear programming and the INFORMAS protocol.

BACKGROUND: Food cost and affordability is one of the main barriers to improve the nutritional quality of diets of the population. However, in Argentina, where over 60% of adults and 40% of children and adolescents are overweight or obese, little is known about the difference in cost and affordability of healthier diets compared to ordinary, less healthy ones. METHODS: We implemented the "optimal approach" proposed by the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS). We modelled the current diet and two types of healthy diets, one equal in energy with the current diet and one 6.3% lower in energy by linear programming. Cost estimations were performed by collecting food product prices and running a Monte Carlo simulation (10,000 iterations) to obtain a range of costs for each model diet. Affordability was measured as the percentage contribution of diet cost vs. average household income in average, poor and extremely poor households and by income deciles. RESULTS: On average, households must spend 32% more money on food to ensure equal energy intake from a healthy diet than from a current model diet. When the energy intake target was reduced by 6.3%, the difference in cost was 22%. There are no reasonably likely situations in which any of these healthy diets could cost less or the same than the current unhealthier one. Over 50% of households would be unable to afford the modelled healthy diets, while 40% could not afford the current diet. CONCLUSIONS: Differential cost and affordability of healthy vs. unhealthy diets are germane to the design of effective public policies to reduce obesity and NCDs in Argentina. It is necessary to implement urgent measures to transform the obesogenic environment, making healthier products more affordable, available and desirable, and discouraging consumption of nutrient-poor, energy-rich foods.

Evaluación de los sistemas de perfiles nutricionales para la definición de una política de etiquetado frontal en Argentina / Evaluation of nutrient profiling systems for the definition of a front-of-pack labelling policy in Argentina

INTRODUCCIÓN: La Organización Mundial de la Salud (OMS) recomienda validar los sistemas de perfiles nutricionales (SPN) tomando como referencia las Guías Alimentarias del país donde se aplican. El objetivo fue evaluar el nivel de acuerdo y exigencia de los SPN latinoamericanos respecto a las Guías Alimentarias para la Población Argentina (GAPA). MÉTODOS: Se evaluó la calidad nutricional de un listado de alimentos según los SPN de la región diseñados para políticas de etiquetado frontal (EF). Se analizó el nivel de acuerdo (índice kappa y Gwet's) y de exigencia (porcentaje de alimentos a limitar) entre las clasificaciones de los SPN y los mensajes de las GAPA. RESULTADOS: Se evaluó un total de 1703 alimentos clasificados en 8 grupos y 48 categorías. Los SPN con mayor nivel de acuerdo con las GAPA fueron el SPN de la Organización Panamericana de la Salud (OPS) (Gwet's=0,663) y el SPN Uruguay (Gwet's=0,651), seguidos por el SPN Chile (Gwet's=0,558) y el SPN Ecuador (Gwet's=0,410) y, por último, el SPN Perú (Gwet's=0,373) y el SPN Bolivia (Gwet's=0,350). En el análisis del nivel de exigencia se observó que al menos uno de los SPN (OPS, Uruguay o Chile) era más exigente que las GAPA en 14 categorías y menos en 4. DISCUSIÓN: Los SPN de OPS y Uruguay son los que más se adecúan a los estándares nutricionales de las GAPA. Este estudio constituye un insumo clave para desarrollar un SPN nacional basado en evidencia científica, que asegure la efectividad de una política de EF

Monitoring Sodium Content in Processed Foods in Argentina 2017-2018: Compliance with National Legislation and Regional Targets.

Sodium intake in Argentina has been estimated to be at least double the dose of 2000 mg/day recommended by WHO, mostly coming from processed foods. Argentina is one of the few countries in the world that have regulated sodium content in certain food products. This study presents an assessment of sodium content in a selection of food groups and categories as reported in the nutrient information panels. We surveyed 3674 food products, and the sodium content of 864 and 1375 of them was compared to the maximum levels according to the Argentinean law and the regional targets, respectively. All food categories presented high variability of sodium content. Over 90% of the products included in the national sodium reduction law were found to be compliant. Food groups with high median sodium, such as condiments, sauces and spreads, and fish and fish products, are not included in the national law. In turn, comparisons with the lower regional targets indicated that almost 50% of the products analyzed had sodium contents above the recommended values. This evidence suggests that enhancing sodium reduction in processed foods may be a necessity for public health objectives and it is also technically feasible in Argentina.